Psycho-neurogene Faktoren bei der Genese lebensbedrohlicher Arrhythmien

Abstract

Tachyarrhytmias often occur during increased emotional arousal or mental excitation. The implantable cardioverter defibrillator (ICD) allows the exact documentation of arrhythmic episodes and their time of onset. Therefore, the type of arrhythmia can be differentiated as well as the circumstances surrounding the event. These features allow the assessment of possible psychic arrhythmogenic factors in the natural environment. We analyzed the ICD-protocols of three male patients (in ages between 60 and 68), whose devices had successfully terminated a ventricular tachycardia and compared the onset of the episodes with the patients' detailed descriptions of the corresponding life situations. The analysis of the circumstances at the time of arrhythmia-onset revealed a relationship between the occurrence of life-threatening arrhythmias in natural environment and emotional stress. The stressors could be defined as situations of increased vulnerability leading to sympathetic excitation. The induction of tachyarrhythmia was promoted in case 1 by acute psychic distress (public speaking), by the increasing panic-attack-like vicious circle of the cognitive anticipation of an unfavorable outcome (case 2), and an adverse anger reaction superimposed on persistent feelings of help- and hopelessness (case 3). These findings are in line with several experimental and epidemiological studies providing evidence for a relationship between psychic arousal and the induction of tachyarrhythmias. The knowledge of emotional and mental factors that function as a trigger for arrhythmias may lead to new therapeutic approaches in the prevention of sudden cardiac death.

Stress-induced cardiac arrhythmias: The heart–brain interaction

“…The autonomic nervous system (ANS) plays a critical role in modulating the neuro-cardiac axis and determines how a person responds to certain triggers. Even in the setting of a structurally normal heart, we can identify changes in the neuro-cardiac axis in response to stress and anger but it appears when there is a substrate for arrhythmia these effects can be detrimental [1,7,8]. There clearly is a difference between some people being more susceptible to the effects of ANS activation, irrespective of whether a structural abnormality is present [1].…”

Tod durch Vorstellungskraft

“…B. nur drei solcher tödlichen psychosozialen Kombinationen dar (vgl. Hofmann et al 1999). Vor allem wegen der Transplantationsmedizin hat heutzutage die Frage nach dem Todeszeitpunkt gerade in den Industrieländern das Interesse der Medizin auf sich gezogen.…”

“…Patienten mit gesteigerter Ängst lichkeit und einer Tendenz zur Unterdrückung von Ärger oder Verleugnung bzw. Verdrängung von aversiven Gemütszuständen, wie auch solche mit der Tendenz zu verringerter Wahrnehmung oder Mitteilung negativ gefärbter Gefühle (Typ-D-Persönlichkeit ), zeigen besonders ausgeprägte sympathikotone Reaktionen auf psychische Stress oren (Hofmann et al 1999;Esler et al 1977;Zotti et al 1991).…”

Angststörungen bei Patienten mit implantiertem Kardioverter-Defibrillator (ICD)

“…Arrhythmische Ereignisse scheinen danach durch erhöhte psychische Erregung ausgelöst werden zu können (Fries et al 2002;Hofmann et al 1999;Lampert et al 2000Lampert et al , 2002. Bei ICD-Patienten mit Panikstörung ergibt sich so u. U. ein Circulus vitiosus, bei dem der lebensrettende ICD-Schock Angst auslöst und diese Angst wiederum weitere ICD-Schocks stimulieren kann.…”